I was going through old photos and found some pictures from around 7 years ago. Apparently back in 2006, I decided to make a self-injurying lego robot. I took pictures of it but am not sure I ever shared them with anyone.
I put the photos under the cut. I don’t believe in trigger warnings, and I think this is more comical/absurd than anything else, but I can respect that some might disagree with me.
Long time without an update. I have been feeling like it’s worth making a post about where I am at now. I don’t think I’ll resume regular posting, but I’ve been thinking a lot recently about how glad I am that I wrote a lot of this stuff out here. I’ve looked back on old posts and can see that my feelings have evolved, but I like that I can access information about where I was at that point in my life. Since in the not far off future I will begin seeing patients of my own, I want to be sure that in my integration into the field as a professional that I don’t forget the vulnerability that comes with being a patient in therapy.
This isn’t to say I am recovered from my mental health difficulties. But I can see now that there are places where I have shifted to slightly more moderate perspectives. For example I now feel the need to ad more qualifiers to my feeling that in moderation, “There is nothing wrong with self injury”. More, now I feel that for me personally the risk benefit/ratio makes it such that it is not an area I feel is worth prioritizing for my treatment. That said, I have considerably decreased the frequency I do it at. But this has been more of an incidental benefit from improvement in other emotional issues. Also, I got a cat. Getting a cat has probably done more to decrease my self-harm than any therapy. For example today on my way home I was visualizing how I would cut as soon as I got in the door. But I walked in and my cat demanded my attention. So I hugged him and now I’m writing this blog post. Maybe I’ll cut later or maybe I won’t. It is hard to say.
I also am trying to be more open to DBT as a treatment. Not for me. But I need to recognize that it does help some people. I am going to make a specific effort to receive training in administering DBT. It’s not easy. Looking at the Marsha Linehan book on my desk makes my heart race. But if I can separate the emotions I feel about being bullied by DBT therapists and pull out the useful bits from that by identifying areas to be more sensitive about, maybe the negative experiences with DBT could make me more effective at administering DBT. That said, I don’t think DBT will ever be my favorite treatment modality, but I can recognize that some people find it helpful.
I’m also making as specific effort to not avoid things due to worries that they may increase the chances of my running into the therapist who kicked me out of my undergrad school. I’m not specifically trying to find events where I might run into him (that would be stalking), but if I am invited to attend an event and am debating whether I should attend, I am making an effort to not factor running into him into my decision. For example I was invited to a wonderful talk by my advisor that was put on my a small organization the therapist-who-kicked me-out-of-school helped to found. I was terrified he would be there, but also knew that the event could be beneficial professionally so I went. He wasn’t there. I’ve no gone to quite a few events where I was terrified of running into him and attended without problem. I’ve really enjoyed going to these events and am glad that I didn’t let the worry hold me back.
Even though a lot of time has passed the fear of being somehow unmasked and losing things I have worked for is still very strong. In my research assistant job I took prior to coming to grad school, those fears started to lessen over time. I reached a point where I felt I was contributing valuable enough efforts to the team that the discovery would not dimmish my hard work. But the fear never fully went away. It’s hard when the fear is partially grounded in reality. There is a risk that if my mental health history were known it would impact me professionally. The problem for me is that my fears are out of proportion and I end up hiding even more than is needed at the expense of forming close relationships. Part of what terrified me about dating is that during a breakup the ex could use information they have learned about me to sabotage my career. It has been roughly 6 years now where I have been unable to form new close friendships. I rely only on the superficial friendships and the people I knew from before it happened.
Some of this maps onto Imposter Syndrome which is very common in graduate students but I feel that my experience is a step beyond what is typical. For the most part in the past with work and undergrad this feeling was limited to hiding my mental health history, but since starting grad school (I’m not even a month in) I feel like it has slammed me in the face. I’m surrounded by so many smart hard working people in my classes. Everyone has such great ideas and asks such clever questions. I am feeling very intimidated. I always tend to beat myself up mentally a bit about things I say, but the current intensity in highly elevated. I worry about not talking enough but then worry about talking too much and if I said stupid things. My anxiety is not usually as social evaluation focused, but this too is unusually increased. I feel like the most awkward one there. I normally don’t care much about the risk of being socially left out but now I’m terrified that I will somehow be ostracized from my cohort if I do something stupid. And then my general distrust comes in because I can’t tell if I am being invited to things because it would be odd to leave out an invite to one member of the cohort or if I am really wanted. Even caring about if I am wanted is a bit unusual for me. I am usually so independent. Things have just started so I imagine that the intensity I am experiencing these things at won’t be sustained, but I am worried that the intense emotions I am feeling will isolate me from my classmates in a way that can’t be repaired over time.
I had to move to go to grad school. I had to leave meeting with SM (the one therapist I made a good connection with). When I resumed meeting with him 2 years ago I tried to tell myself that it might be possible for me to not need therapy after the 2 years. That was not a realistic goal. So I am now meeting with therapist #28. The area I have moved to has a lower therapist per square mile density than I have had in the past. When I also factor in how many of the therapists in the area might be people I will encounter in my academic training I simply can not afford to go back into my cycle of firing a therapist every couple of months. There are just not enough therapists around form me to do that. So I am trying very hard to stick with #28. If I leave, I need to have a very good reason and need to try to not do it impulsively. This is tough because I feel that every therapist I have left I have had a good reason to leave and that it was well thought out. I know there’s no way for me to go through 28 therapists without me contributing something to the problem, but on an individual therapist level it is very hard to see it as anything other than a problem with one particular therapist.
I have only had a couple of appointments with #28 so far. It’s so frustrating to start over and so hard to gauge if things will work. Having a therapist like SM who saw me over a period of 6 years (although with large gaps of seeing other therapists during that time when I was living too far away from him) and knows the history and associations I have with different things and how some of my views have shifted is so valuable. In talking with #28 about some of the social anxiety I am experiencing I get so frustrated needing to interrupt my flow to throw in background information. I am trying with 28, but I don’t feel connected to her. Everything feels forced and unnatural.
She made a comment that freaked me out a lot. If she knew more about me she’d have realized not to say it. Going to avoid the specifics here to avoid identifying myself too much. But the simple issue is that she made an “if ___ then ____” relating to an action she might take if a certain thing turned out to be true. This is an action which would be undesirable to me. She told me this in response to my worrying about whether this thing might be true. It has turned out that the thing I was worried about is not true, but while I was still worried about that I had a new added worry about whether I needed to lie to 28 if it did turn out to be true to avoid her doing the undesirable thing. Sorry that is so convoluted. The simple issue here though is that she created a situation in which my providing her information might hurt me and made me need to consider lying in therapy. I hate lying in therapy. This is one of the things about no-harm contacts and such that infuriate me (that’s not what this was). Rather than help me deal with the situation they create an environment where I feel I can’t be honest which defeats the point of therapy. It’s tough to have an issue like this come up so early. I feel like if I am honest and say that it upset me and stressed me out because I felt like I might need to lie to hide it that she might think I am actually lying about the thing we had talked about before. But if I don’t mention it I get to stew over it and feel like I can’t have open communication. It’s so hard to get things to where I was with SM. If SM had somehow done the same thing I’d feel comfortable telling him and not worry about repercussions of my words. But in this new environment I am worrying that my words will be used against me. This type of problem is the kind of thing that I know is capable of building up into something that causes me to leave therapy.
SM and I are doing brief monthly check in phone calls to ease the transition. I get to talk with him Monday, right before my appointment with 28 so maybe he can help me figure out how to deal with it. The therapy transition is tough. I’ve been having so many new experiences and challenges that I want to be able to talk through with someone. I try to picture in my head talking to #28 about these things and the image and interest in talking fizzles away. But if I think about talking to SM it feels comfortable. Even in my imaginary visualizations of therapy he is better.
I do want to avoid having this end on a negative note. I am incredibly happy with the program I am in. Everything so far has been confirming that I made the right choice with this school. I just need to handle the anxiety enough to get the most out of it.
I think about self-injury a lot. Most days I don’t self-injure, but most days I think about self-injuring.
In the earlier days of my self-injury the thought would pop into my head and in most cases I would do it as soon as I could following the idea.
I didn’t care about getting blood on my clothes and often wore dark pants that would hide the blood stains.
I wanted to self-injure and then it was off to the nearest bathroom. That’s an exaggeration. I still thought of self-injury more than I acted on it, but I acted on it much more quickly when I did. Certainly external events would sometimes prevent me from doing it, but I’d often find ways, even if it meant secretly scratching myself with a safety-pin under my clothing.
That was high school. Things shifted in college.
It’s obviously more comfortable to self-injure in my bathroom than in a public one. In high school waiting until I got home meant waiting until the end of the day. In college, waiting until I got home often meant waiting however long it would take me travel there. Sometimes that means waiting until a class is over, but rarely the long waits I would have in high school.
I began opting to wait a bit to have the better self-injury experience at home rather than the scared “I hope I don’t get caught” one in a public bathroom. I don’t always do this. I still punch trees, sign posts and walls while walking places, but those days are more extreme than most.
This waiting has stretched out more and more. When before it was waiting 3 hours for a class to end, now I’ll wait the whole work day. Almost all of my self-injury now occurs at night. Self-injury at night is routine, but in the day time is a sign of trouble.
The freedom is crucial. It’s not that anyone is telling me I can’t self-injure then. I can do it if I want to, but often opt to instead wait for the preferred environment.
I picture the self-injury in my head. Imagining the cuts on my body. Sometimes I move a finger briskly across the location I will cut. I think of watching the blood drip down my leg.
And these images in my head are soothing. I plan, “I’ll self-injure when I get home”. Knowing that option and plan is there helps.
I fully intend in the moment to self-injure when I arrive home. But often by the time I arrive at home, my mind is on to other things. Sometimes I self-injure and others I don’t. The intention is the same when the initial thought arrives, but the intervening experiences vary, leading to different outcomes.
I want to be sure to differentiate what I am talking about from therapy techniques where a therapist authoritatively tells a client that they should stop self injuring by trying to wait X amount of time and then revisit the idea.
This is a process that has evolved on its own rather than being artificially forced upon me.
I am not waiting as a means of ultimately avoiding self-injury. As I have said, I don’t think self-injury in moderation is objectionable.
But do I prefer to bleed through a pair of pajama bottoms rather than a nice pair of pants? Yes.
Do I like looking down at my leg throughout the day to be sure blood isn’t visible to people? Not really.
In the moment, I believe with a high degree of certainty that I will self-injure when I arrive at home.
It just turns out that I am not very good at predicting this.
I recently had an occasion where I was concerned I might need to change clothing in front of another person. I wasn’t sure and it turned out not to be the case, but I was very worried about it at the time.
If no fresh cuts are visible I can angle my body so that scars might not be seen.
I had to avoid self-injuring for a few days after I learned of this event. I go weeks without self-injuring fairly regularly. I thought a few days would be nothing.
Once I told myself I couldn’t self-injure my stress skyrocketed. I couldn’t visualize the self-injury. It only worked when I believed in the moment that I would do it for real when I was home. The images were nothing without the hope of reality.
I’d not been fully aware how often the thoughts were in my head. As soon as you try not to do something it becomes so much worse.
The thoughts themselves are soothing. I need the possibility to be open.
I can’t force any of this. It only works if the thoughts are spontaneous.
I was able to avoid self-injuring, but it was not an enjoyable few days.
I’ve found a similar phenomenon occurs with my therapy.
When I am in therapy I have frequent conversations in my head with my therapist. All the conversations are ones I imagine I could have with the therapist. Often they are difficult topics I’m struggling to bring up and I replay the scene over and over looking for the right way to present information.
My actual therapy sessions only vaguely resemble their imagined versions. Some topics from my visualizations do get brought up in my real therapy, but most do not.
The pretend therapy in my head is a useful tool for sorting out thoughts and often by the time I get to therapy I don’t need to talk about that issue any longer.
When I am not in therapy this process doesn’t work. I have to be able to think the conversation could take place. Without it my brain becomes a cluttered mess.
When in therapy that doesn’t seem to help much in session, the pretend therapist in my head that I gain access to can be more valuable than the session itself.
Without therapy I sometimes shift to imagined blogging, which is not as good as imagined therapy, but serves a similar function.
As you likely already know, a draft of the DSM 5 came out Wednesday.
There’s a lot of interesting stuff to look through, but the part I had the biggest reaction to was the addition of Non-Suicidal Self Injury. Funny that this is what interested me, because in general research on self-injury bores me.
My initial reaction was entirely positive, but after some more thought I realized some potential problems. So, here’s a list of pros and cons.
Pros:
Too often people who self injure get stuck with the borderline personality disorder diagnosis who don’t meet the criteria only because they self injure. In the paper explaining the rationale for this addition (It’s a quick read. I recommend skimming through it if you’re at all interested) the authors mention that self injury occurs in many different disorders.
The specific wording in the title differentiates self injury from a suicide attempt. Hopefully this can help to cut down on some of the overreaction from practitioners about self injury.
Cons:
Does self injury really belong as its own disorder? Are there people who self injure on multiple occasions without any other diagnosis? Is there research on this? Seems strange to add a disorder that might only rarely be seen in isolation, increasing problems of co-morbidity.
But I understand that the way the DSM is set up, it has to be its own disorder or nothing at all. Possibly the benefits outweigh the negatives of added co-morbidity.
In the article (page 10-11) the authors justify self-injury as a separate phenomena by mentioning a longitudinal study showing that self injury decreased independent of other symptoms. This study was done only on patients with borderline diagnoses, not sure it is fair to generalize this to other patients especially because this new disorder plays a role to separate self injury away from only borderline personality disorder.
My largest problem is with section B: “The behavior and its consequences cause clinically significant distress or impairment in interpersonal, academic, or other important areas of functioning.”
This seems like a benign thing to add. Similar qualifiers are in every disorder.
Here’s the problem: The way it is written right now, I don’t meet the criteria for this disorder. I don’t have impairment or distress from the self injury, but I have a lot of that from the feelings leading up to the self injury.
Seems silly. No one would try to argue with me that what I do is self injury. I’ve even participated in a number of studies researching non-suicidal self injury. Those studies could easily be used to support inclusion of this diagnosis, wouldn’t make sense for their participants to not all qualify.
Instead, I feel section B should be written something like this: “The behavior, its consequences and/or feelings precipitating the behavior cause clinically significant distress or impairment in interpersonal, academic, or other important areas of functioning.”
The current writing reflects an unfortunate trend to treat self-injury as the problem rather than the reasons for self injury. Certainly many people feel guilt over their self injury, but this is not the case with everyone.
The authors touched upon a similar idea in their section, “Placement in the system: A Mood or a Behavior Disorder?” (Pages 8-9). Much of their argument leads towards placing it in mood disorders, with a side note of similarity towards impulse control disorders, so it seems strange for the mood component to be omitted from the impairment part of the diagnostic criteria.
A partial hospital program is sometimes also called a day program. You spend the day at the hospital, but then go home to sleep.
My first partial hospital program was right after my first hospitalization. I lasted two days there.
This is the program that I mentioned in my post about how they sent me someone else’s records.
The social worker in my hospitalization set up the intake at the partial hospital program for me.
I told her two requirements I had for it:
1. It needed to be an adolescent program
2. I did not want to do DBT
When the social worker informed me it was set up, she told me my requirements had been met.
When I arrived on the first day, I quickly learned neither request had been fulfilled.
I realize now that avoiding DBT in this type of program is likely an impossibility, but I’d have appreciated her being upfront with me about this. To be fair she probably didn’t know the program contained DBT. But the reason for this is probably because she didn’t put any effort to find out.
My request for an adolescent program was reasonable. I was 19. My inpatient hospitalization had been with adolescents (their cut off was age 21).
There was a group of about 6 others in the program. I was by far the youngest. Most were old enough to be my parents.
I was very uncomfortable. I listened to people complain about their children and spouses. I couldn’t relate.
At my intake meeting a ‘No Harm Contract’ was presented.
‘No way’, I said ‘I will self injure if I want to and forcing me to sign that just will force me to lie. I’d rather not need to lie.’
The contract was pushed aside to be reevaluated in the future.
I left that meeting with the understanding that I had in no way suggested I would refrain from self-injuring.
I was very angry and aggressive (verbally, not physically). Largely because I was stuck at this partial hospital program because I’d been kicked out of school and possibly also in a small part because of a bad reaction I was having to Celexa.
I was under the impression that successful completion of this program was necessary to help my return to school. Despite despising the program, I felt I needed to stick it out.
The first day was a Friday. That weekend I returned to the school to move everything out of my dorm room.
Most was removed Saturday. Sunday morning I came to retrieve the last few items and discovered another person sleeping in what had been my bed and a large bong in the bathroom.
Monday I returned to the partial hospital program. The first day I had left my sharp items at home. I wasn’t sure what I was getting into (would my items be searched?) and decided it was in my best interests to leave them at home. Monday, the second day, I came prepared with a swiss army knife in my pocket. This seemed fine based on my experience the first day.
Inpatient hospitalizations are under-structured. Too much time with nothing to do. Partial hospital programs are over-structured. One group after another. Spending the entire day dwelling on problems, because the structure prevents one from going out and doing anything enjoyable.
I was frustrated with the way the people leading the groups spoke down to us, as if the depression meant we were cognitively challenged.
During the lunch break I made a few little tiny cuts on my leg. Very minimal, close to zero blood draw.
In the afternoon I had a daily check-in meeting with a social worker. As a side note I mentioned cutting a little during lunch. I didn’t think it was a big deal to mention. I’d never agreed to the no harm contract.
I was transported into an office with another woman (someone with a higher level of authority). She demanded to see what I’d used. I handed over the knife.
A lecture proceeded in a disgusted tone, wondering how I could have possibly thought it was acceptable to bring a “weapon” (aka a small swiss army knife) into a hospital.
She demanded to see the cuts.
I refused, explaining they were minimal and did not need medical attention.
She argued that because I had done it “on the premises” she had to see them.
I continued to refuse.
“I’d have to take off my pants to show you”, I protested.
She seemed unconcerned.
I was scared and eventually intimidated into giving in.
I tried rolling up the pant leg to show the cuts, but as I’d suspected the leg wouldn’t push up far enough.
I unzipped, pulled down my pants and showed her the cuts.
I felt very violated.
“Well there’s not too much damage this time“, she huffed.
That was it. The last straw. I announced I was leaving the program.
She bombarded me with questions assessing my current suicidal risk, trying to trick me into saying something to allow them to keep me there.
I didn’t fall for it.
My knife was returned and I went home.
I still didn’t have a therapist. While making phone calls to find one, many therapists refused to see me on the basis that I’d not properly completed the partial hospital program. I only was able to get into therapy (although this was my fake therapy, because anything I said was at risk of being reported back to my school) eventually when I left out the bit about the incomplete partial program.
I used to believe there was never a legitimate reason to withhold information from a primary care doctor. Now I feel that information is only to be given on a need to know basis.
In late high school, my therapist (M.S.) gave me three choices, I could go on medication, go back to DBT or go to my primary care doctor to get my cuts looked at. If I refused select one of them, she wouldn’t meet with me anymore. I resented the ultimatum, but decided to go for the primary care option. Medication and DBT would be continued disruptions to my life but a trip to the doctor could be done and over with in a day.
I didn’t have any control over making my own doctor appointments or transporting myself to the doctor. My parents don’t know about my cutting so I couldn’t tell them why I needed to go.
I invented a vague medical issue (I can’t remember what, maybe a stomach ache?) and asked to go to the doctor. Given my Mom’s hysterical tendency to overreact to physical symptoms, this was all I needed to get an appointment.
I went to the appointment and no surprise, my cuts did not need medical attention, but the therapist didn’t trust my judgment.
I thought I was done with the primary care task, but the therapist kept insisting I periodically return.
More vague medical issues were invented. My cuts were fine. I make a lot of cuts, but the depth of each individual one is nothing to worry about.
One visit, my regular doctor wasn’t in and instead I met with an overemotional doctor who grabbed my arm and made me promise not to kill myself.
When I was hospitalized for the first time it was partially related to losing my virginity. Although I know that with lesbian sex the risks are lower, I decided to ask for a STD test. The HIV test was done while I was in the hospital, but the other more general test was not.
I was 19, but my primary care doctor was still my pediatrician. Google says that up to age 21 people sometimes still see their pediatrician, but for me age 19 felt much too old. I didn’t have control over making doctors appointments yet and hadn’t been comfortable asking my parents about switching. The doctors at the hospital helped me out by writing in my discharge report, “Recommend the patient establish care with gynecologist”.
Upon release from the hospital I had an appointment with the new primary care doctor. I got my STD test (Results were fine). That was the only appointment I ever had with her.
Much later, I was trying to find a therapist. A local hospital’s psychology department said they could get me one, but first I needed a primary care doctor in their hospital. I made an appointment to see this new doctor (I will call her Doctor A). I gave a fairly lengthy psych history to her, because I needed her to help me get a therapist within her hospital. She seemed very nice and insisted she’d help me get a therapy appointment quickly.
The hospital wasn’t able to follow through with getting me a therapist. The wait list was a month long and even after the wait I wouldn’t be able to have a high enough frequency of appointments.
Another local hospital said they too could find me a therapist if I had a primary care doctor in their hospital. Again, I went to a new primary care doctor who I told more about my psychological history than my physical history. This hospital was also not able to follow through on their promise of a therapist.
I decided to switch back to Doctor A because her hospital had a more convenient location. Both hospitals are affiliated with the same prestigious medical school so I believed they were of comparable quality. Turns out the USnews rankings feel strongly otherwise, but I didn’t know this at the time.
I had a handful of appointments with Doctor A. I needed a form signed for school, the HPV vaccination, I had the flu etc.
I wasn’t pleased with how she handled my medical form for my new school. She put much too much information down about my psychological history. I felt the only appropriate information was the medication I was on (klonopin) and a small reference to minor anxiety as an explanation. I didn’t feel comfortable using her form with what had happened last time I had a school know my psychological history.
I never gave my new school the medical form. I’ve avoided the student health center. I worried they would track me down looking for it, but it never happened.
My third hospitalization was at Doctor A’s hospital. The many ways that that hospitalization was the worst I’ve had are a subject for another post. When I was discharged they insisted I make a follow-up appointment with my primary care doctor. The next available appointment was many months outward. The appointment was made and although I felt it was unnecessary I kept in in my calendar book.
After the hospitalization at Doctor A’s hospital I requested a copy of my records. I really only cared about the records from my inpatient stay, but because I was already going through the effort of making the request I also checked the box asking for my primary care records.
In my initial appointment with Doctor A I had mentioned that I am a lesbian. I was also asked if I am sexually active. I find that a hard question to answer; I explained that I only had sex once. I was asked if it had been consensual and I told her it was. At the time I didn’t think much of the question about consent, it seemed like a reasonable follow up.
In my records I was surprised to find this:
“She has had one sexual encounter with a man 1 year ago, but has not had intercourse since. She considers herself a lesbian but does not have a girlfriend and is not sexually active.”
I definitely never said anything about having sex with a man! I’ve only had sex with a woman. At the follow-up appointment I called her out on this. She was very insistent that I had told her I had sex with a man.
She heard the statements “I have had sex once” and “I am a lesbian”. I think this was likely not conscious, but I believe she was biased to assume that “sex” is a man plus a woman even though intellectually I believe she understands the alternatives. So following that she asked the question about consent, because it didn’t make sense for a lesbian to have sex with a man unless it was rape. There are of course exceptions to this, such as when a person begins identifying as a lesbian later in life. Instead of asking for clarification she assumed I was one of those exceptions and entered the incorrect information into my record.
I wasn’t pleased to learn that my doctor had an implicit bias against homosexuals. I realize there are some leaps and assumptions in here, but I think it is the most logical explanation of what happened.
I decided I was done with preventative medicine. I have chronic suicidal ideation. Although I wasn’t going to take action to kill myself then, I shouldn’t take action to keep myself alive. Basic needs such as eating and sleeping were okay, but no need for check-ups. Maybe I would come down with a horrible disease and would die without needing the effort of killing myself.
Eventually, I loosened up on my boycott of preventative medicine. I found a new primary care doctor (Doctor B), one at a clinic with a focus on the LGBT community. I told Doctor B the bare minimum of psychological history; I let her know the medications I am on, and mentioned nothing other than occasional panic attacks and ADHD. That’s all she needs to know. If she doesn’t know more, then she can’t tell more on any forms I need her to sign.
In September when I had my most recent overdose, I wanted to go to a doctor to get checked out. I couldn’t go to to Doctor B, because I don’t want her knowing about my crazy.
I waited a week to avoid the risk of being forcibly hospitalized. The more time between me and the overdose the less of a case they would have that I was an immediate danger to myself.
Doctor A was a resident and no longer works in the same hospital, but the hospital assigned me a new primary care doctor who I have never met. As far as Doctor A’s hospital is concerned I still have a primary care doctor there. I just haven’t been to an appointment for awhile. This gave me access to their walk-in clinic.
I met with a doctor who insisted I needed an emergency appointment with their psych department. Because it was after hours and I wasn’t an immediate risk she said she’d call tomorrow with a referral for an urgent appointment. I didn’t argue because I didn’t want to say anything that might force me to stay there. But it was frustrating, because I’d come for the physical issues only.
Everything was fine physically in her tests besides my reported GI symptoms (they eventually faded away).
I dutifully followed up with all of the hoops to get the urgent appointment. I was without therapy so I figured it couldn’t hurt. The appointment never materialized. No surprise there.
I would probably go back there if I needed other medical attention related to my psychological issues. I don’t like them but they’re capable of running a blood test or giving an X-ray. Doctor B is still my doctor for yearly appointments and anything else .
I don’t know which doctor is my real primary care doctor. Neither has the full story. Each has their specialized purpose. It works, so I’ll keep it like this.
I should preface this post by mentioning that I don’t feel self-injury is inherently bad, it can be helpful so I find efforts of others to prevent me from doing it frustrating. You might with to read my other post about self injury first.
When I began self-injuring I also began hiding tools to accomplish it. This way I would always have access should I feel the need. Safety pins were hidden in most articles of my clothing. I had a pencil case filled with razor blades and bloody gauze.
In my first hospitalization I secretly brought in a safety pin. A small item I impulsively decided to hide when I realized what was happening. Turned out this was unnecessary.
They did an awful job of searching my things. When my searched bag was handed to me the first thing I did was open a compartment and pull out a brand new razor blade. My roommate had packed the bag and handed it to my parents. The razor blade had been left in the bag previously.
To make it seem I was healthier than I was I promptly handed the razor to the mental health worker who had given me the bag. My manipulation was wasted. This interaction was never entered into my records and I don’t believe he told anyone because it was him who had missed the blade in the search.
Upon later inspection I realized all of my buttons (the kind with little sayings on them and pins on the back) had been left on my bag. I had accumulated a very large assortment of sharp items.
Initially I had decided I would respect the rules of the hospital and not self injure while there, but after a series of frustrations with the hospital I decided there was no reason for that.
I scratched up my arm a bit one day. Hardly any damage, it’s tough to do much with a pin. I didn’t hide it but also didn’t show it off. It was noticed and I handed over some of the pins.
A threat was made, “Is this everything? We can search all your things again if you want”
“Search if you want too”, I said
I made good eye contact. They bought my pretend confidence.
Later, feeling manipulative again I walked to the nurses station with a pin and said, “Here, I found this in my room”
The nurse made a big fuss about how proud of me she was, not knowing I still had my original safety pin. This was entered in my notes.
I scratched a bit at times following and was not caught.
In the weeks preceding my second hospitalization I knew I was feeling unstable. I had destructive plans running through my head with no specific time set.
In the event that I needed to be hospitalized I decided I should ensure I would have materials to self-injure with in the hospital. I hid razor blades in many items that are always on my person.
Sure enough when I was rushed to the ER I had a nice assortment of sharp new blades. None were found during the search. No one expects the lengths I went to conceal them.
I had quite the stash of blades. I cut a lot during that hospitalization and was not caught.
The closest I came was when I was cutting and punching a wall in the shower. The wall punching made more noise than I anticipated and nurses came barging into the bathroom. Fortunately through feigned modesty and angling my body in ways to hide the cuts, I was able to get enough privacy to get clothing on without being caught. I admitted to the wall punching but the cutting and razor blade were not discovered.
On the day I was being discharged, minutes before I left, I passed a clean new blade to a friend I’d met there. She’d mentioned wanting to cut and being friendly I decided to help her out. It’s a fuzzy moral area for me. It’s one thing for me to cut. I know I won’t go too deep, but other people are uncontrolled variables.
Later I heard she cut up her arm pretty badly and was discovered. She wouldn’t give up my name though when the psychiatrist was demanding the information from her.
At my third hospitalization I also arrived well armed with razor blades. The ER room I sat in had a spare unused blood draw kit. I was bored with making balloons out of latex gloves so I took it and hid it for later.
An accomplishment I shouldn’t be proud of but am is that during this hospitalization I cut in the shower while on one to one security. Meaning, I had a person who’s sole job was to babysit me and make sure I didn’t do these sorts of things and still managed to not get caught.
I tried to draw blood with the blood kit. I thought it would be neat to try and bleed until I passed out. I was doing it wrong. It didn’t work. I tried calling a friend with a history of heroin abuse (the same one who I gave the blade to the previous hospitalization) I thought maybe she would have advice regarding sticking a needle in an arm. She didn’t answer the phone.
I later learned those kits are set up to only work when the blood tube is attached. I didn’t have any tubes.
I was trying to express to the doctors how not okay I was. I gave them useless the blood kit and some of the razors that had become rusty from the shower. I wanted them to know what I’d been up to. It didn’t work. I was discharged the next day despite still being very suicidal. First thing I did upon arriving home was OD on a bunch of pills.
Having so many sharp things hidden in my possession makes airplane travel very stressful. I’m fine with sneaking sharps into a hospital, but not fine with sneaking them onto a plane. The consequences of being caught in the hospital are very low, but being caught with it at an airport is serious business. Before a trip I have to carefully comb through every single possible hiding spot and remove the blades. There are so many I don’t remember them all. I’m incredibly anxious while going through security. I worry if i missed one.
To make matters worse I nearly always have my bag searched additionally. I travel with at least three cameras on the average trip, along with assorted other electronic devices. No matter how I pack these items, my bag appears suspicious under X-ray.
Fortunately it appears I’ve never accidentally left a razor blade behind in my bag, but it continues to be a source of worry every time.
If you are someone who works at a hospital I hope you don’t take out of this post that security needs to be drastically upped for everyone. I think a better message is that if a person wants to do something badly enough they will find a way to do it. Also it is important to note, that most of the in hospital self injury I did was directly following attempts to reach out to staff for help verbally that were unsuccessful.
As you can tell from my post about food, I am very particular about what goes into my body.
It was an ordeal for my parents to get me to take any kind of medicine as a child. Any occasion where I took medicine was a rarity. I had no understanding of the cause and effect. The idea that something I ingest would alter how I felt (possibly in a positive way) was hard for me to understand.
My freshman year of high school my parents decided they wanted me to begin taking Adderall. I refused initially. I wasn’t worried about potential risks of the drug. Taking a doctor prescribed drug as directed seemed harmless. I knew cognitively about the idea of side effects, but had no personal experience and therefore was not concerned. My reason for objecting was taste.
I’ve never learned to swallow pills. I have to place them in food. The bitter taste is inescapable.
My parents offered to pay me to take the Adderall. I forget how much. It was a one time payment in exchange for taking the drug indefinitely. I’m not much of negotiator, I probably could have gotten a better deal, but I accepted it.
I began the Adderall.
I have no memory of ever being told by a doctor what side effects to look our for. My parents were told, but I wasn’t.
So when I stopped needing to eat or sleep much I didn’t connect this to the new drug. I just thought I didn’t need these things anymore.
I’d sneak over to the computer at night and play games online. Go to bed at 3 am wake up at 7:30 am? No problem!
I loved my alone time at night. I had free reign of the house, provided I was quiet.
Why would I tell my parents? They’d just get mad at me for sneaking out of bed.
I didn’t need lunch anymore. I’d save my lunch money for various odds and ends.
Couldn’t tell my parents that either, they’d get mad.
Classes were boring. I’d look around the room going pondering the different ways I could kill myself before the class ended. Could I jump out the window? Hang myself with the flagpole? It was half serious and half a game.
I exploded at a friend at school. She asked where my boyfriend and I were going on our date. I accused her of trying to follow us. I never repaired that friendship following this incident.
I started self-injury during this time. Was it something that was bound to happen even without the Adderall? I have no way of knowing.
Based on how long standing my problems have been and my family history I believe I’d still have had difficulties without ever taking Adderall. I think they may have just been accelerated.
During this time I feel something in me broke. I’ve spent the rest of my life trying to fix it, but I never get back to where I was. I have times when I think I am fixed, but a little bump makes me fall apart again.
My fabulous, amazing godfather commented that I looked drugged. And he would know, what with all the time in the 80s he spent being punk rocker, hanging around the east village.
There were a lot of dramatic, loud arguments with my Mom. One resulted in my running into a snow storm in only a t-shirt and jeans. I figured I’d freeze myself to death in the snow. I hid in the backyard, then I got cold, so I decided to live.
I re-entered my home. My dad was on the phone with a local psych unit. Had I stayed outside a few more minutes I’d have been dragged to the hospital.
This was my first threat of psych hospitalization. It began a series of nightmares I had for years about being forcibly hospitalized. (This is a topic for another post)
I wonder sometimes how things might be different had I been hospitalized that day. If some type of intervention had been made earlier would things be less severe today? My parents were and still are for the most part clueless about how bad my problems are. It was a year until I began regular therapy and it wasn’t due to a specific mental health diagnosis except for a little about my ADD. It was primarily for dealing with conflict between my mom and I.
After the snow storm incident, my parents finally realized the Adderall was not the best idea for me and I was taken off it.
Life improved after quitting the Adderall, but never quite to where it was before. The self injury tapered off, to the point where I thought I was done with it forever. There was almost a year where things felt close to normal. A rough patch during my junior year brought everything back. It was much easier to fall apart the second time.
You’d think this would have scared me away from stimulants for good, wouldn’t you?
It did for awhile. It scared me away from all drugs.
Out of desperation, my freshman year of college, I tried some other psych drugs for my anxiety and depression. (This is a topic for another post) This loosened up my fear somewhat. I’m still very distrustful of drugs, but if desperate enough I’m willing to look into the option, occasionally.
When I transfered schools I was terrified about how I would do academically.
During my second hospitalization I asked my doctor if he could prescribe an ADD medication besides Adderall. I thought it would be a good idea to try it while there so if I had a bad reaction I would be in a safe place.
The doctor said no. He had a theory that I was bipolar type 3 (didn’t seem to care that this diagnosis doesn’t exist) and thought it would make me manic.
In art therapy I spaced out while the directions were being explained. I dedicated my piece of colorful scribbles to him and called it “My therapist won’t give me ADD drugs, so I spaced out during the directions”. In typical art therapy fashion the facilitators talked about how even though I’d not heard the directions, my scribbles somehow related to the assigned topic.
During my 3rd hospitalization I asked again. They put me on Ritalin. Was the only helpful thing to come out of that hospitalization. Originally they had me take it every day. I wasn’t comfortable with that.
Now I take Ritalin just on days I want to. I like being able to compare how I feel on the drug versus off it. It has worked out very well.
Everything in my brain organizes itself better. I don’t stare at a blank screen for hours trying to start a paper.
It’s not perfect. I’ve had horrible mood swings when it wears off. I learned this happens when I skip a meal. I make sure to eat (even if I’m not hungry) and things are fine.
Careful self-monitoring is important.
Ritalin is shorter acting than Adderall. I find this helpful. I can’t go for weeks accidentally depriving myself of sleep and food like I did on Adderall.
Part of my Adderall problem was that I wasn’t informed about anything. I was 14. I was young, but old enough that I should have had a more active role in my health decisions. Someone should have let me know that my body still needed food and sleep even if it was saying otherwise.
I was a freshman in high school. I sat in a bubble bath with the shower curtain pulled shut, adding an extra layer of protection added to the closed, but unlocked bathroom door. The lock didn’t work. Few of the locks in my parents’ house worked. At any moment my mother could rush into the bathroom unannounced.
At the time she was occupied screaming with my father about something, most likely related to my above average, but not up to her standards, academic performance.
I needed the shower curtain shut so she couldn’t see me with a shaving razor in my hand slicing open my leg, watching the blood mix with the bubbles.
The first dozen or so times I did this are mashed into one entity in my head. I want to know, what was different about that night that made me cut my leg open instead of just crying? At the time it didn’t seem at all significant. Now I wish I’d written something down.
I love having records of things. Without records I feel like maybe something didn’t happen. I want a physical representation of experience. I document. I write, I take photos and I make scars.
Scars leave records. A scar is easier to live with than remembering the details of why I have a scar. For this time period I have neither. The scars have faded and I wrote very little down.
Within weeks of the first injuries to my legs I began taking apart shaving razors. I didn’t want to keep all that plastic designed to “help” prevent me from cutting myself. Each shaver gave me three little blades. They were so tiny and seemed delicate. I hid them in a makeup compact.
It’s over 6 years later now. I still do it. Not as often as in the early days, but often enough that I identify as a “self-injurer”.
I don’t feel the same way many do about self-injury. I don’t think it is a bad thing. Don’t get me wrong, I don’t think it is a wonderful thing. It has flaws. In moderation, I think there is nothing wrong with self-injury. I don’t want to stop. I just want to stop the feeling that make me want to do it.
I used to be one of those people who mentally beats themselves up after self-injuring. No more. I’ve enough other things to mentally beat myself up over. I don’t need to add another.
I have never needed stitches. I have never lost a dangerous amount of blood. I have never gotten an infection. I am careful.
Much of my therapy has been a struggle. I want to not feel upset enough to want to cut. They want me to stop cutting, without fixing the underlying problem. The priorities are different.
Those same therapists will advocate the use of klonopin when I want to cut. I consider klonopin a worse way of dealing with stress than cutting. In my hierarchy of not-so-positive-ways to deal with stress klonopin rates worse than cutting. When I cut I can see the damage being done. With klonopin I can’t.
I wouldn’t advocate it to others. I realize there are negatives. I have scars. I deal with the pain the following days. I consider these negatives to be acceptable for me. I realize most people dosn’t feel this way.
I also realize that most people who self-injure consider it a struggle. For me the struggle is what leads up to the self-injury, not the self-injury. But I do support those who feel differently.
Self-injury helps me stay alive. I can short curcuit negative thoughts spiraling downward. I can prevent my mental state from further deteriorating.
In my first hospitalization the doctor drew a picture of my cuts. It’s in my records It amused me quite a bit that going to med school resulted in her drawing a picture of my cuts.
I believe on the right is supposed to be a drawing of the bruise that was on my hand from punching the floor.
The tic-tac-toe one is my 2nd favorite, the first being the skull. The tic-tac-toe one has some faux symbolism that’s so corny I can’t even say it with a straight face. “The X’s represent life. They won before I could make a move” See it started out one day I decided to do a tic-tac-toe board. No particular symbolism or anything. It’s hard to make curves with the knife so I just made Xs, no Os. I cut over the same spots many times. Eventually I gave that meaning to it, despite the original purpose being visual, not symbolic.
Visuals are important for me with self-injury. I have to see what I’m doing. If I punch a wall I need to see the bruise. Otherwise it is not as effective.
I like the skull because I think it is cute. One the left leg cuts must be parallel (the skull is the exception). The right leg allows chaotic criss-crossing cuts.
I’m rambling now so I guess I’ll stop. I’ll just end things by saying that for me self-injury is helpful. Often times mental health professionals ignore its adaptive function and try to eliminate it without fixing the problem or understanding it. I fight them every step of the way. And then I get labeled as difficult. They worry excessivly about the risks, not realizing that I am careful. If they paid closer attention they’d realize that my anxious, obsessive traits carry over into my self-injury. I’m much more likly to panic and over react thinking a cut is far worse than it is than I am to underreact.
Trichotillomania. I can’t spell the words “schedule“, “definitely” or “regularly” without the help of spellcheck, but I can spell “trichotillomania“. It’s a good thing, because wordpress’s spellcheck doesn’t recognize trichotillomania as a word.
Trichotillomania (compulsive hair pulling) is the one diagnosis I have that all mental health professionals I’ve met with are in agreement about. I, however, feel very out of place in internet communities for those who share my diagnosis. I don’t pull from my scalp, so my problem is more easily hidden. As a result, I don’t suffer from the social consequences that many people have to deal with.
My favorite hairs to pull are ingrown ones. They don’t belong. They’re already defective, they are guilt free pulling.
First I notice the irritation of the skin. Sometimes I can see the hair sometimes I can’t. When the area is more inflamed I poke it with a pin to release the fluid. Digging with tweezers, pins and fingernails I search for the hidden hair. Sometimes blood obstructs my work. I have to allow a day of rest before resuming.
I question the existence of the hair. Maybe I already pulled this one out and forgot? Maybe the skin was irritated from something other than a hair? Was that a shadow or a hair?
After some healing, I recommence my hair retrieval mission. When finally I free the hair from my , then mutilated, skin, I feel immense satisfaction. The greater the length of the hair the greater the satisfaction. The visual is very important to me. I study it wondering how long it had been hiding in my body. Sometimes dead skin is firmly attached to the strand. I slide it off carefully, examine both hair and skin individually and dispose of them.
I replay the scene over and over in my head, eagerly awaiting my next opportunity to repeat it.
Nose hairs are my second most favorite type of hair to pull. They are also the most uncomfortable to discuss. There’s such social stigma about putting fingers up a nose, pulling out a hair there is even worse. I can comfortably tell therapists I pull pubic hair, but often omit the nose hair.
Using tweezers makes me sneeze, so fingers are the way to go. I wonder about the risks of pulling a hair with such an obvious purpose (filtration of the air). I justify it by pointing out to myself, ‘I can’t reach all of them to pull. The ones farther up are still in place functioning.’ I don’t seem to get sick more than average so I suppose it’s fine.
Eyebrows and eyelashes are the source of the most post-pulling-guilt. I start with light tugs. The hairs coming out in my hands are ones that were about to fall out anyway, right? If I’m not careful this quickly escalates into harder tugs. Now it’s uneven. I have to keep pulling to even things out, right? I have to finish the job. It’s all or nothing. Fortunately, I’ve had this more under control in recent years. I started wearing makeup more often. Mascara makes it easier to accidentally pull more hairs in one tug, but seeing the mascara on my hands helps to remind me to stop. Seeing eyeshadow on my hands when pulling eyebrows helps the same way. Wouldn’t want smudgy makeup, would I?
I also pull arm, leg and underarm hair. These are the socially accepted places for hair removal, but I take it to an extreme. Shaving feels like cheating. The hair is still there. I want it gone. I am in a constant struggle to remove it all. There is always that one hair I missed. I remove that and then there’s another.
I use an epilator (basically electronic tweezers) to remove it. I advocate epilators as aggressively as some women advocate diva cups (diva cups freak me out by the way. I bought one and it sits in my desk unused). Epilating is a very soothing experience for me. Unfortunately is as a noisy device. I try to minimize the time I use it when others are home. I don’t want people realizing how much time I spend removing hair.
At times when I don’t have access to an epilator I will eventually begin pulling out the hairs individually. I can tolerate a certain amount of hair, but I have a limit. That limit is lower when stressed. At my first hospitalization I reach that limit. The staff didn’t understand my situation and wouldn’t let me use my epilator because it had a cord (no wires allowed. I could strangle myself -_-). They also misunderstood my trichotillomania as a type of self-injury. I was individually pulling out my hairs, gripping them with my finger nails. I reached the point where I was wiling to compromise with shaving. I couldn’t have a razor to shave either, because I cut. My roommate, who was allowed to shave, took pity on me and allowed me to use her razor on the condition that she supervised to see I didn’t cut. It was very much appreciated. I was eventually allowed access to the epilator under supervision from staff.
Let me elaborate on that point I just made. Trichotillomania is not self-injury. Some people might pull their hair as self-injury, but that is not trichotillomania.
When I self-injure I want to see destruction. When I pull I aim for perfection.
I self-injure as a direct response to stress. I know I will release that stress by self-injuring.
I often start pulling without even noticing. While stress may play a role, it is not the entire explanation. I pull at times I am bored or have inactive hands as well as in reaction to stress.
What they do have in common for me is the importance of visuals. I have to see the hair I pull out, just like I need to see the damage from my self-injury.
I tend to pull more with my right hand than left, which is interesting as it is my non-dominant hand. Pulling with my left hand feels strange.
I have some ideas regarding environmental root * causes for my hair pulling, but I’ll save that for another post.
*ahah poor word choice
Tales of a Crazy Psychology Major 